Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort

Lee, Shing Fung; Nikšić, Maja; Rachet, Bernard; Sánchez, María‐José; Luque-Fernandez, Miguel Ángel

doi:10.3390/cancers13071514

Cited by 8 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these studies did not examine individual risk in the context of community-level impacts [ 12 , 13 ]. A recent study of 18,917 participants in the UK Biobank showed that ethnic minority background and community-level socioeconomic status assessed by the Townsend Deprivation Index are important COVID-19 risk factors among individuals with cancer [29] . Our analysis provides robust results that address this gap by concurrently examining personal exposure to COVID-19, occupation, and comorbid conditions, and community-level socioeconomic factors on a population scale using participant information not commonly available in registry or hospital-based cohorts.…”

Section: Discussionmentioning

confidence: 99%

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Lo¹,

Nguyen²,

Drew³

et al. 2021

eClinicalMedicine

View full text Add to dashboard Cite

Background There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19). Methods We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509. Findings Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18–1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33–1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02–1.34), South Asian (OR, 1.39; 95% CI, 1.30–1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18–1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively. Interpretation Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.

show abstract

Section: Discussionmentioning

confidence: 99%

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Lo¹,

Nguyen²,

Drew³

et al. 2021

eClinicalMedicine

View full text Add to dashboard Cite

show abstract

“…Many focused on large established cohorts like UK Biobank that could rapidly link to data on SARS-CoV-2 testing (34), COVID-19 hospitalization (35) and mortality (36). Since then, many risk factors have been reported, including smoking (37, 38, 39, 40, 41, 42), diabetes (38, 43, 44, 45), asthma (46, 47) and vitamin D (48, 49) as predisposing to worse outcomes. We compared our results to the literature on COVID-19 in UK Biobank to identify any differences to standard approaches and find new insights.…”

Section: Resultsmentioning

confidence: 99%

Identifying direct risk factors in UK Biobank with simultaneous Bayesian-frequentist model-averaged hypothesis testing using Doublethink

Arning,

Fryer,

Wilson

2024

Preprint

View full text Add to dashboard Cite

Big data approaches to discovering non-genetic risk factors have lagged behind genome-wide association studies that routinely uncover novel genetic risk factors for diverse diseases. Instead, epidemiology typically focuses on candidate risk factors. Since modern biobanks contain thousands of potential risk factors, candidate approaches may introduce bias, inadequately control for multiple testing, and miss important signals. Bayesian model averaging offers a solution, but classical statistics predominates, perhaps because of concern that the prior unduly influences results. Here we show that simultaneous Bayesian and frequentist discovery of direct risk factors is possible via a model-averaged hypothesis testing approach for large samples called ‘Doublethink’. Doublethink produces interchangeable posterior odds andp-values that control the false discovery rate (FDR) and familywise error rate (FWER). We implement the Doublethink approach in R and apply it to discover direct risk factors for COVID-19 hospitalization in 2020 among 1,912 variables in UK Biobank. We find nine exposome-wide significant variables at 9% FDR and 0.05% FWER. These include several commonly reported risk factors (e.g. age, sex, obesity) but exclude others (e.g. diabetes, cardiovascular disease, hypertension) which might be mediated through variables measuring general comorbidity (e.g. numbers of medications). We identify significant direct effects among infrequently reported risk factors (psychiatric disorders, infection, dementia and aging), and show how testing groups of correlated variables is a useful alternative to pre-analysis variable selection. We discuss the potential for impact and limitations of joint Bayesian-frequentist inference, and the mutual insights afforded into the long-standing differences on statistical approaches to scientific discovery.

show abstract

“…8 11 12 Similarly, scholars have been called to shift their research focus from solely describing inequalities towards analysing processes that are amenable to change and identifying implementable solutions that help advance social and equity agendas. 10 11 …”

Section: Discussionmentioning

confidence: 99%

“…This situation has led international organisations and governments to review and reinforce their cancer strategies posing central attention on reducing inequalities, particularly among historically marginalised populations 8 11 12. Similarly, scholars have been called to shift their research focus from solely describing inequalities towards analysing processes that are amenable to change and identifying implementable solutions that help advance social and equity agendas 10 11…”

Section: Discussionmentioning

confidence: 99%

“…In the same period, the reduced access to healthcare resulted in excess of ‘non-COVID-19’ deaths, including excess deaths from cancer 7 8. The ongoing pandemic continues to impact cancer services and people living with cancer 9 10. In response, international organisations and governments are reinforcing their strategies to recover cancer services and to reduce inequalities 8 11 12.…”

Section: Study Rationalementioning

confidence: 99%

See 1 more Smart Citation

Relationship between intersectionality and cancer inequalities: a scoping review protocol

et al. 2023

View full text Add to dashboard Cite

IntroductionPersistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries.Methods and analysisThis study will be guided by Arksey and O’Malley’s, and Levacet al’s frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report.Ethics and disseminationEthical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.

show abstract

Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort

Cited by 8 publications

References 28 publications

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Identifying direct risk factors in UK Biobank with simultaneous Bayesian-frequentist model-averaged hypothesis testing using Doublethink

Relationship between intersectionality and cancer inequalities: a scoping review protocol

Contact Info

Product

Resources

About